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Browsing by Author "Bergoeing, Michel"

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Acute Symptomatic Free-Floating Thrombus in the Innominate Artery, a Case Series
(2022) Ignacio Torrealba, Jose; Valdes, Francisco J.; Garrido, Luis; Mertens, Renato; Marine, Leopoldo; Bergoeing, Michel; Vargas, Francisco
Background Innominate artery embolism may result in upper extremity ischemia or stroke. A free-floating thrombus originating from the IA is an unusual and dangerous disorder with embolic potential. Only isolated cases have been described showing different treatment modalities. Purpose To present 3 cases of free-floating thrombus in the IA treated at our institution with 3 different approaches. Cases The first case is a patient with a free-floating thrombus in the IA treated with cervical debranching and ligation of the proximal right carotid artery; another case of a patient treated with a hybrid approach with deployment of an iliac limb in the IA plus right carotid to subclavian bypass; and a third case of a patient operated by open arch thrombectomy. Conclusions Free-floating thrombus in the IA is a threatening condition feasible to be managed through different customized surgical approaches in specialized centers.
Endovascular repair of abdominal aortic aneurysm.: Results in 80 consecutive patients
(2006) Valdes, Francisco; Mertens, Renato; Kramer, Albrecht; Bergoeing, Michel; Marine, Leopoldo; Canessa, Roberto; Huete, Alvaro; Vergara, Jeanette; Valdebenito, Magaly; Rivera, Dixiana
Background: Endovascular repair of abdominal aortic aneurysms (AAA) avoids laparotomy, shortens hospital stay and reduces morbidity and mortality related to surgical repair allowing full patient recovery in less time. Aim: To report short and long term results of endovascular repair of AAA in 80 consecutive patients treated at our institution. Patients and Methods: Between September 1997 and February 2005, three women and 77 men with a mean age 73.6 +/- 7.7 years with AAA 5.8 +/- 1.0 cm in diameter, were treated. The surgical risk of 38% of patients was grade III according to the American Society Anesthesiologists classification. Each procedure was performed in the operating room, under local or regional anesthesia, with the aid of digital substraction angiography. The endograft was deployed through the femoral artery (83,7016 bifurcated 16.3% tubular graft). A femoro-femoral bypass was required in 11.3% of cases. Follow-tip included a spiral CT scan at 1, 6 and 12 months postoperatively, and then annually). Results. Endovascular repair was successfully completed in 79/80 patients (98.7% technical success). The procedures lasted 147 +/- 71 min. Length of stay in the observation unit was 20.6 +/- 73.5 h. Blood transfusion was required in 10%. Sixty two percent of the patients were discharged before 72 h. One patient died 8 days after surgery due to a myocardial infarction (1.3%. During follow-up (3-90 months), 1 patient developed late AAA enlargement due to a type I endoleak, requiring a new endograft. No AAA rupture was observed. Survival at 4 years was 84.2% (SE = 9.2). Endovascular re-intervention free survival was 82.7% (SE = 9.5). Conclusion: Endovascular surgery allows affective exclusion of AAA avoiding progressive enlargement and/or rupture and is a good alternative to open repair Close and frequent postoperative follow up is mandatory.
Erdheim-Chester disease. Report of one case
(SOC MEDICA SANTIAGO, 2011) Vega, Jorge; Cisternas, Marcela; Bergoeing, Michel; Espinosa, Roberto; Zapico, Alvaro; Chadid, Pedro; Santamarina, Mario
We report a 76-year-old male who was admitted due to progressive congestive heart failure lasting several months. An echocardiogram showed a large pericardial effusion with early signs of pericardial tamponade and an irregular surface suggestive of cancer infiltration. The patient was operated, creating a pericardial window and draining 1,200 ml of a brownish yellow fluid with abundant cellularity. Pericardial biopsy showed infiltration by CD68 (+), CD1a (-) and S100 (-) cells. Twenty-eight months earlier, due to fatigue, dyspnea, and a non-specific inflammatory process, an enhanced-contrast-scan showed that aorta was coated with a hypodense tissue that began near the aortic valve and extended until the inferior mesenteric artery, with stenosis of the left subclavian, celiac axis, renal and upper mesenteric arteries. An angioplasty and stent placing was carried out in the last two arteries. Both kidneys had the appearance of "hairy kidneys". A bone scan showed increased uptake in femurs and tibiae and X-ray examination showed osteosclerosis in metaphysis and diaphysis. The diagnosis of Erdheim-Chester disease (non-Langerhans-cell histiocytosis) was made and the patient was treated with steroids and methotrexate. (Rev Med Chile 2011; 139: 1054-1059).
Extra anatomical revascularization and endovascular stent-grafting for thoracoabdominal aneurysm repair. Report of four cases
(2007) Mertens, Renato; Valdes, Francisco; Kramer, Albrecht; Marine, Leopoldo; Bergoeing, Michel; Sagues, Rodrigo; Huete, Alvaro; Vergara, Jeannette; Valdebenito, Magaly
Surgical treatment of thoracoabdominal aneurysms is a big technical challenge with a high rate of complications and mortality. It requires a large exposure and transient interruption of vital organ perfusion during its repair. Endovascular repair is a less invasive alternative available over the last decade. We report four male patients aged 44 to 76 years, with thoracic aortic aneurysms and involvement of visceral aorta, treated with a two stage procedure. During the first stage, a retrograde revascularization of the superior mesenteric and renal arteries from the infrarenal aorta was done, associated in two cases to a concomitant repair of an infrarenal aortic aneurysm. In the second stage, an endovascular graft was placed through the femoral artery, from the segment proximal to the aneurysm to the infrarenal aorta, above the origin of the visceral artery reconstructions, excluding the aneurysm from circulation. In one patient, both stages were concomitant and in three the second stage was delayed. One patient presented a postoperative bleeding that required reintervention without adverse consequences. No patient died, presented paraplegia or deterioration of renal function. After follow up of 6 to 20 months, there is no evidence of aneurysm growth or complications derived from the procedure.
Isolated Abdominal Aortic Dissection With and Without Abdominal Aortic Aneurysm
(2024) Gonzalez-Urquijo, Mauricio; Marine, Leopoldo; Valdes, Francisco; Vargas, Jose Francisco; Bergoeing, Michel; Mertens, Renato
Objective The aim of this study was to report the clinical presentation and treatment outcomes of patients treated for IAAD with and without abdominal aortic aneurysm (AAA) in a single academic institution in South America.Materials and Methods A retrospective review of all patients with IAAD with or without concomitant AAA between January 2002 and December 2023 from a single academic hospital was performed.Results Eighteen patients with IAAD were diagnosed of whom 13 (72.2%) were males. Median age was 63 years (range: 43-88 years). Sixteen (88.8%) patients presented with symptoms, and in two (11.1%) asymptomatic patients IAAD was an incidental finding. Ten (55.5%) patients had concomitant abdominal aortic aneurysm (AAA), with a median size of the aneurysm of 49.5 mm (range: 44-66 mm). No statistical differences in baseline characteristics were seen between patients with concomitant IAAD and AAA and patients with only IAAD. Seven (38.8%) patients presented chronic dissection, and 11 (61.1%) patients had acute dissection. Five (27.7%) patients were treated conservatively with blood pressure, pain control, and antiplatelets; endovascular surgery was performed in eight (44.4%) patients and open surgery in five (27.7%) patients. The complication rate was 22.2% (n = 4), and the mortality rate was 0%. Median follow-up was 36 months (range: 6-240 months). Complete remodeling was seen in all patients except two patients who underwent conservative treatment. Of those, one had partial remodeling, and the other no changed.Conclusion Isolated aortic dissection of the abdominal aorta is an uncommon condition, with acceptable different treatment strategies, from conservative to invasive treatments. Sometimes IAAD can concur with AAA, and when so, invasive treatment might be considered. More studies describing the natural history of AAA and its association with IAAD are warranted, as well as further research reporting long-term outcomes on aortic remodeling after different treatment modalities.
Isquemia de extremidades inferiores secundaria a arteritis de la arteria temporal
(2020) Zarate Bertoglio, Cristián; Martínez Ruiz-Esquide, María Eugenia; Sfeir Vottero, Pedro Ignacio; Drazic B., Obren; Vargas S., José F.; Torrealba, José; Bergoeing, Michel; Mariné, Leopoldo; Valdés, Francisco; Mertens, Renato
Giant cell arteritis is more common in women older than 60 years, is associated with systemic inflammation symptoms and mainly involves the aortic arch and cranial arteries, specially the temporal artery. Symptomatic lower extremity arterial stenosis or occlusion is uncommon and can lead to limb loss. We report a 73-year-old woman presenting with a one-month history of lower extremity intermittent claudication of sudden onset. She also complained of fever, malaise, headache and weight loss. A non-invasive vascular study showed moderate femoral popliteal occlusive disease, with and abnormal ankle-brachial index (0.68 and 0.83 on right and left sides, respectively). An angio-computed tomography showed thickening of the aortic wall and severe stenosis in both superficial femoral arteries. Steroidal treatment was started, and a temporal artery biopsy was performed confirming giant cell arteritis. Six weeks after steroid therapy the patient had a complete remission of symptoms. A serologic exacerbation was subsequently treated with a humanized monoclonal antibody against the interleukin-6 receptor Tocilizumab, obtaining long time remission.
Late effect of an embolized coronary stent in the lower extremities
(2025) González Urquijo, Mauricio; Valdés, Francisco; Marine, Leopoldo; Vargas, José Francisco; Bergoeing, Michel
To report a late complication involving an embolized stent that migrated into the peripheral circulation during an emergency coronary intervention. Case Report: A 69-year-old man with a history of myocardial infarction 12 years prior, during which he experienced prolonged cardiac arrest following a failed coronary stenting attempt and subsequent aorto-coronary bypass surgery, presented to the emergency department with acute limb ischemia in the right lower limb. A CT angiogram revealed complete occlusion of the popliteal artery and a hyperdense image at the tibioperoneal trunk. Popliteal artery exploration and embolectomy successfully restored proximal blood flow; however, a firm occlusion at the tibioperoneal trunk necessitated an arteriotomy. This procedure uncovered a coronary stent adhered to the endothelium, which was removed via endarterectomy. The patient was prescribed rivaroxaban for six months. At a six-year follow-up, he remains well and asymptomatic, continuing on aspirin and a reduced dose of rivaroxaban. Conclusion: This case underscores the importance of monitoring long-term complications following coronary interventions and highlights the need for vigilance in managing patients at risk for device embolization.
Management of Spontaneous Isolated Celiac Artery Dissection
(2024) Gonzalez-Urquijo, Mauricio; Vargas, Jose Francisco; Marine, Leopoldo; Mertens, Nicolas; Valdes, Francisco; Bergoeing, Michel; Mertens, Renato
Background: Spontaneous isolated celiac artery dissection (SICAD) is uncommon, with very few series reported in the literature. The present study aims to describe the clinical characteristics and treatment outcomes of patients with SICAD treated at a single Chilean institution over 20 years. Methods: A retrospective review of all patients from a single academic hospital with SICAD diagnosed between January 2003 and March 2023 was performed. Conservative treatment included antiplatelets, anticoagulation, or both. The normal size of a celiac artery in our population was 7.9 +/- 0.79 mm in females and 8.3 +/- 1.08 mm in males. We defined a celiac artery with a diameter equal to or more than 12.5 mm as an aneurysmal celiac artery. Results: The cohort included 27 patients; 77.8% (n = 21) were males. The median age was 51.0 years (range: 38-84 years). Fourteen (51.8%) patients presented with aneurysmal dilatation. Fourteen (51.8%) patients were treated with antiplatelets, 6 (22.2%) patients with anticoagulation, and 7 (25.9%) with anticoagulation and antiplatelets. One patient was treated with endovascular therapy due to a pseudoaneurysm of the celiac artery detected 10 days after conservative treatment with antiplatelets. The median length of hospital stay was 5 days (range: 214 days). Complete remodeling was seen in 6 (22.2%) patients, partial remodeling in 10 (37.0%) patients, and no change was seen in 8 (26.9%) patients. Three (11.5%) patients were lost to follow-up. There were no significant differences between treatments and remodeling outcomes (P = 0.729). The median celiac artery diameter of patients with aneurysmal dilatation was 13.5 mm (range: 12.5-20.5 mm). Systemic arterial hypertension was found more commonly in patients who presented with aneurysmal dilatation than in patients without (87.5% vs. 12.5%, respectively, P = 0.016). Mean follow-up was 41.5 months and median follow-up was 16 months (range: 6-204 months). Conclusions: Most patients with SICAD can be treated conservatively with excellent outcomes. Hypertension was more commonly found in patients with SICAD and aneurysmal dilatation.
Pelvic intravenous leiomyomatosis with intracardiac extension. Report of two cases
(SOC MEDICA SANTIAGO, 2012) Mertens, Renato; Valdes, Francisco; Munoz, Cecilia; Irarrazaval, Manuel; Branes, Jorge; Riquelme, Carlos; Marine, Leopoldo; Bergoeing, Michel; Kraemer, Albrecht
Intravenous leiomyomatosis with extension into the heart is an infrequent entity described in 1907. Its clinical presentation is non-specific, although cardiac symptoms predominate. Diagnosis is based on clinical findings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years. (Rev Med Chile 2012; 140: 906-909).
Pulmonary Aneurysmal Arteriovenous Malformation Treated With a Vascular Plug
(2024) Gonzalez-Urquijo, Mauricio; Marchesini, Michelle; Marine, Leopoldo; Vargas, Jose Francisco; Bergoeing, Michel; Mertens, Renato; Valdes, Francisco
Purpose To report a case of an asymptomatic patient with a pulmonary aneurysmal arterio-venous malformation successfully treated with a vascular plug.Case report An active 30-year-old male patient, residing at 3000 ft above sea level was referred due to an incidental finding on a CT scan of a 37 mm vascular mass localized in the lower lobe of the right lung, which corresponded to a pulmonary arteriovenous malformation with a single feeding artery. The patient was treated with an Amplatzer vascular plug, which effectively excluded the afferent vessel. An angio CT at 19 months follow-up revealed a hypodense residual mass of 9.0 mm in diameter with no arterial filling or venous drainage. The patient is fully active and remains asymptomatic at 24 months follow-up.Conclusion An unusual case of a pulmonary aneurysmal arteriovenous malformation successfully treated with a vascular plug is presented, highlighting the efficiency of this procedure.
True Idiopathic Brachial Artery Aneurysm Treated With a Saphenous Vein Graft
(2022) Gonzalez-Urquijo, Mauricio; Marine, Leopoldo; Vargas, Jose Francisco; Valdes, Francisco; Mertens, Renato; Bergoeing, Michel; Torrealba, Jose
Purpose: The objective of this study is to report a case of a 65-year-old woman who presented with pallor and pain of her left arm secondary to a true arterial brachial aneurysm, which was successfully treated with saphenous vein bypass and embolization of the aneurysm sac. A review of the literature is also presented. Case report: A 65-year-old woman presented with an acute onset of pallor and pain of her left forearm, and hand. On physical examination, there was a pulsatile mass at the forearm. A doppler ultrasound showed a fusiform aneurysmal dilatation of the brachial artery of 23 mm of diameter. A dynamic contrast-enhanced MRI angiogram confirmed a fusiform dilation of the distal brachial artery. The patient was scheduled for open repair. A fusiform 20 x 60 mm aneurysm of the distal brachial artery extending to the cubital fossa was found and a brachial artery to radial and ulnar arteries bypass with interposed reverse right saphenous vein was created. Embolization of the aneurysm sac was performed using Gelita-spon (R) (Gelita Medical, Eberbach, Germany). A final angiogram showed an adequate perfusion through the bypass to the hand, and no contrast in the aneurysmal sac. Postoperative course was uneventful with discharge on the fourth postoperative day. Conclusion: Revascularization with autologous saphenous vein graft and exclusion of the aneurysm with local embolization is a good treatment alternative in a patient with symptomatic brachial aneurysm with distal embolization.
Ventana Fenestrated Stent-Graft System for Endovascular Repair of Juxtarenal Aortic Aneurysms
(ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS, 2012) Mertens, Renato; Bergoeing, Michel; Marine, Leopoldo; Valdes, Francisco; Kraemer, Albrecht; Vergara, Jeanette
Purpose: To describe the initial use of an off-the-shelf fenestrated stent-graft system for endovascular repair of juxtarenal abdominal aortic aneurysms.

Browsing by Author "Bergoeing, Michel"

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